Regional differences in long-term mortality among hospital-treated asthma and COPD patients.
Chronic obstructive pulmonary diseases, which have increased due to smoking and ageing of the population, constitute a national health problem, the treatment of which can be expected to arouse considerable discussion in health care organisations currently preoccupied with economic problems. Although extensive medication and easy access to treatment are often regarded as therapeutically desirable, it may be questioned whether they have any impact on objective measures such as mortality. International recommendations for the early treatment of asthma have met with satisfaction and the asthma situation can be said to be under control, even though occurrences tend to be on the increase. It should be noted, however, that the COPD treatment recommendations still remain to be tested and the general attitude towards treatment is still reserved, even pessimistic. By combining data from the Finnish national hospital discharge register and register of deaths with findings regarding the use of medications, differences in the survival of asthmatic and COPD patients can be discerned between areas with different treatment practices. Stressing the fact that effect-differences between different treatment strategies can not be proven on the basis register data and that random clinical trials are needed to gain further knowledge in the field, our results show that extensive medication and easy access to treatment are characteristic of areas where the survival of asthmatics and COPD patients is better.
Tuuponen
T
T
Department of Public Health Science and General Practice, University of Oulu, Finland.
Keistinen
T
T
Kivelä
S L
SL
D001249:Asthma / Q000401:mortality* / Q000628:therapy; D002423:Cause of Death; D005260:Female; D005387:Finland / Q000453:epidemiology; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries